Download - đO thị ngọc hiếu breast cancer, epidemiology and screening in vietnam jfim hanoi 2015
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BREAST CANCER
EPIDEMIOLOGY AND SCREENING
IN VIETNAM
BS Đỗ Thị Ngọc Hiếu,
BS Hồ Hoàng Thảo Quyên BS Võ Tấn Đức
UNIVERSITY MEDICAL CENTER HCMC HANOI 11/2015
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CONTENTS 1. Epidemiology 2. Screening ¢ American Cancer Society Recomendations ¢ Application of diagnostic imaging
modalities in Vietnam
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1. EPIDEMIOLOGY
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Breast cancer (BC): ¢ Most common cancer in
women worldwide ¢ Leading causes of death ¢ IARC-International Agency
for Research on Cancer 2012: � # 1.7 million new cases
(25% cancer in female) � 522.000 deaths (#15% cancer)
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1. EPIDEMIOLOGY
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1. EPIDEMIOLOGY
Trends in incidence of female BC in selected countries: ASR per 100,000
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30,6 33,5
36,2 38 40,5
19 21,9 23,9
26,4 27,7
0 5
10 15 20 25 30 35 40 45
2004 2005 2006 2007 2008
ASR in Ha Noi and HCMC
Ha Noi TPHCM
Trends in incidence of female BC in Hanoi and HCMC Source:Trends of BC in Vietnam VN Cancer Magazine, 04/2013
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1. EPIDEMIOLOGY
Estimated age-standardised rate (ASR) of BC in VN
Source:Trends of BC in Vietnam, VN Cancer Society, 04-2013
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Ha Noi
TP HCM
Cần Thơ
Thừa thiên Huế
Hai Phong
Thai Nguyên
Viet Nam
2004-2008 39.4 26.0 22.6
20.7 16.1
14.5
26.6
2020 38.1
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1. EPIDEMIOLOGY
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11,9 26,6
41,1
86,8
107,1
128 115,3 110,4
63,5 49
0
20
40
60
80
100
120
140
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+
Tỉ lệ
Nhóm tuổi
Breast cancer incidence by age (2004-2008)
Source:Trends of BC in VN, VN Cancer Society, 04-2013
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1. EPIDEMIOLOGY
BC stages
Source:Trends of BC in Vietnam, VN Cancer Society, 04-2013 8
Stage BC cases in 5 regions
(%)
I 463 11.7
II 1.105 27.9
III 2.387 60.4
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2. BREAST CANCER SCREENING
American Cancer Society (ACS): ¢ Tests and exams used to find BC before it
causes symptoms ¢ Improves the chances that BC can be
found early and treated successfully
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2. BREAST CANCER SCREENING
ACS Guideline, Oct 20, 2015 For women at average risk (most women) ¢ Age 45 – 54: yearly mammograms 40 - 44: Start screening, if they want to ¢ ≥ 55: mammograms every 2 or 1 years ¢ Regular mammograms as long as in good health ¢ Breast exams, medical provider or self-exams, are
no longer recommended. Still, all women should be familiar with how their breasts normally look and feel
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2. BREAST CANCER SCREENING
ACS Guideline, Oct 20, 2015 Women at higher risk: MRI+mammogram every year Includes: ¢ Lifetime risk ≥ 20%-25% (tools, based mainly on family history) ¢ Known BRCA1 or BRCA2 gene mutation ¢ First-degree relative with BRCA1, BRCA2 mutation ¢ Had chest radiation therapy ¢ Have Li-Fraumeni, Cowden, or Bannayan-Riley-
Ruvalcaba syndrome, or first-degree relatives have
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2. BREAST CANCER SCREENING
ACS Guideline, Oct 20, 2015 MRI screening: ¢ The ACS recommends against MRI screening for
whose lifetime risk of BC < 15%. ¢ Not enough evidence for yearly MRI screening for
moderately increased risk � Lifetime risk of BC 15% - 20% � Personal history of BC, DCIS, LCIS, ADH, ALH � Having dense breasts on a mammogram
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2. BREAST CANCER SCREENING
ACS Guideline, Oct 20, 2015 MRI screening: ¢ do at a facility that can do an MRI-guided biopsy at
the same time. Otherwise, a second MRI done at another facility when she has the biopsy.
¢ more sensitive than mammograms, higher false-positive rate
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2. BREAST CANCER SCREENING
ACS Guideline, Oct 20, 2015 Ultrasound (US) as a screening test : ¢ Some studies have suggested US + mammogram
screening for dense breast ¢ US aren’t used by themselves for screening ¢ Less sensitive than MRI ¢ Automated USàneed a second handheld US
� To get more pictures � Guide a needle biopsy of a suspicious mass.
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2. BREAST CANCER SCREENING ACS Guideline, Oct 20, 2015 US most often used to: ¢ evaluate breast problems ¢ guide a needle biopsy of a suspicious mass. ¢ look at lymph nodes/ breast tumor
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2. BREAST CANCER SCREENING
BC screening in VN Main diagnostic imaging modalities:
� US � Mammogram � MRI
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2. BREAST CANCER SCREENING ACR BI-RADS
¢ The American College of Radiology Breast Imaging Reporting and Data System
¢ Standardize reporting and follow-up ¢ 1980s: for mammograms, from 2003: for US and MRI newest: 5th Edition 2013
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2. BREAST CANCER SCREENING ACR BI-RADS
ACR 2013 18
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ACR 2013
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2. BREAST CANCER SCREENING BI-RADS LEXICONS MRI
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BREAST MRI LEXICON
Mass Shape Margin Internal Enhancement
Non-Mass-Like Distribution Internal Enhancement
Symmetry
Kinetics Initial phase Rapid Medium Slow
Delayed phase Wash-out Plataeu Persistent
Associated Findings
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MAMMOGRAM VS US
Mammogram advantages
US advantages
Fatty breast Calcifications outside mass Architectural distorsion Asymmetry
Mass/Dense breast DDX cyst vs solid Tumor vascularization Realtime
Screening vs Diagnosis v Screening: no symptoms or signs of BC v Diagnosis: breast problem or an abnormal area found in a
screening test, exam
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TYPE OF BREAST
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2. BREAST CANCER SCREENING
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2. BREAST CANCER SCREENING Mammograms, suspicious calcifications The Radiology Assistant
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2. BREAST CANCER SCREENING Mammograms, architectural distorsion
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2. BREAST CANCER SCREENING Mammograms, asymmetry The Radiology Assistant
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2. BREAST CANCER SCREENING
US Background influence sensitivity
Sonoworld
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2. BREAST CANCER SCREENING
US, cyst vs solid
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2. BREAST CANCER SCREENING
US, Galactocele vs papillary neoplasm Sonoworld
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US, BIRADS 4C
Sonoworld
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2. BREAST CANCER SCREENING
MRI
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2. BREAST CANCER SCREENING
MRI, Mass and non-mass like BIRADS 4
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2. BREAST CANCER SCREENING Practical situation in Viet Nam: Majority: ¢ US and Mammograms ¢ MRI after US, Mammograms in high risk women
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2. BREAST CANCER SCREENING Practical situation in Vietnam: ¢ In some regions:
� US screening � if US or exam find problem à Mammograms
Maybe due to : � Dense breast � US: low cost, widely available � BC screening fee have not coveraged by Insurance � Lack of BC screening information
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